Non-stimulant treatment of ADHD

Juan D. Pedraza, Jefrey H. Newcorn

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

1 Scopus citations

Abstract

Introduction and rationale The psychostimulants, primarily methylphenidate (MPH) and amphetamine (AMPH), are the most effective and frequently prescribed medications for attention-deficit hyperactivity disorder (ADHD). Hundreds of controlled clinical trials have established the utility of these medications in reducing the overactivity, impulsivity, and inattention characteristic of children with ADHD, leading to improvement in a wide variety of associated behaviors, including academic performance, social functioning, and disruptive behavior. The effect size of stimulant medication for treatment of core ADHD symptoms is considered to be large, making these medications among the most effective treatments in psychiatric practice. Moreover, the tolerability profile of stimulants is considered to be quite agreeable. Yet, despite their overall robust efficacy and reasonable tolerability profile, stimulant treatments have their limitations, as outlined below. Response. Some patients do not tolerate stimulant treatments well or do not achieve optimal symptom reduction with these medications. For example, in the Multimodal Treatment Study of Children with ADHD (i.e., MTA study), only 56% of patients had an optimal response (defined as a composite rating of “1” on a composite scale comprising symptoms of ADHD and oppositional defiant disorder [ODD]) to well-titrated medication treatment, primarily stimulants (and almost exclusively immediate-release formulations, since the MTA study was conducted in the mid to late 1990s), using all available compounds and formulations; approximately 20% of the patients did not respond to treatment with either stimulant class [1]. In addition, while the 14-month MTA findings [2] clearly established the relative superiority of assignment to the MTA medication algorithm over behavior interventions over the course of 1 year (i.e., relatively long-term improvement), findings from the 36- and 72-month follow-up assessments suggest that the superiority of intensive, carefully monitored medication management gradually dissipates when children are returned to community treatment. While this result does not contradict the findings of robust efficacy of acute stimulant treatment, it does suggest the importance of considering multiple perspectives regarding intervention [3, 4].

Original languageEnglish
Title of host publicationAttention-Deficit Hyperactivity Disorder in Adults and Children
PublisherCambridge University Press
Pages259-275
Number of pages17
ISBN (Electronic)9781139035491
ISBN (Print)9780521113984
DOIs
StatePublished - 1 Jan 2015

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